OUTSOURCINGA LIFE

Scant surrogacy regulations mean uncertainty, risks

About the project

This story was primarily reported over 13 days in May and June in Anand and Khambhat, India. Further reporting was done in San Carlos and San Francisco. The Akanksha Infertility Clinic in Anand allowed a Chronicle reporter and photographer full access to its facilities, except for the delivery room. The scenes and conversations in this story were either witnessed firsthand or reconstructed through interviews with those present. Interpreter Jignasha Pandya helped conduct all interviews with those who spoke the Indian language of Gujarati and contributed reporting.

The unlikely pairing of the Kowalskis and Manisha Parmar is but one of hundreds to take place since 2002, when India legalized commercial surrogacy.

Jennifer, Steve and Manisha say they look back more or less favorably on their experience. But the process is not always so smooth, largely because of the absence of national regulations.

In 2005, the Indian Council of Medical Research laid out non-mandatory guidelines for the accreditation, supervision and regulation of surrogacy and assisted reproduction clinics. Later, the government drafted legislation that incorporated these guidelines, but it is still pending in Parliament. One proposal circulated this summer would bar foreigners from the practice, according to India news reports.

Defenders of the practice call it a win-win for both infertile couples and the underclass women who serve as surrogates. But advocates say that surrogates, physicians, medical-tourism agencies and clients are left to make up their own rules, sometimes with worrisome outcomes.

Surrogates' salaries, for example, are "arbitrarily decided by the clinics," according to a report last spring from the Center for Social Research. The women's advocacy group surveyed 100 surrogates at clinics in Mumbai and New Delhi - not including Dr. Nayna Patel's in Anand as well as parents, doctors and surrogacy agencies.

The group also found that surrogates often do not know the terms of their contracts, nor are they given copies of the documents. The rights of those who miscarry, and payments for those who end up with twins, are unclear. While guidelines suggest that surrogates undergo no more than three rounds of in vitro fertilization to become pregnant, some are put through more.

"Surrogacy poses a series of social, ethical and legal issues which remain unanswered," the authors wrote.

The heavy emotions involved can mask the reality of the risks, said Marcy Darnovsky, executive director of the Center for Genetics and Society, a bioethics watchdog group in Berkeley, who was not involved with the report.

"This idea that this is women helping women and the surrogate is giving a gift, that kind of muddies the water," she said. "It kind of blurs this obvious point that, if we're treating this as a business, then regulate it like a business to be regulated."

But not everyone is thrilled about the prospect of new laws. After a government agency proposed to block foreign clients from surrogacy, some 70 surrogates penned a letter of protest. The industry provides a much-needed opportunity to break out of poverty, they argued, adding that Dr. Patel takes care of their health.

The Assisted Reproductive Technologies Regulation Bill tries to address some of the complications by issuing protections for surrogates, such as setting a maximum number of times she can give birth. It would also impose penalties on clinics that do not comply.

This bill is still pending, however, and the rules are ever-changing. Separate recently adopted regulations adopted late last year effectively ban same-sex couples and single parents from the trade.